UK - Nurse Lucy Letby Faces 22 Charges - 7 Murder/15 Attempted Murder of Babies #15

[magikarpmagikarp]

I think they were working with the unknown and adrenaline had worked on previous collapses of a similar nature. It's alleged the air bubble blocked the chambers of the heart, so really the amount of adrenaline is not the concern here. It's not as though the adrenalin itself was administered with ill intent.

Yes. And thinking back to the testimony, the baby had had "a good gas" right before the final, fatal collapse... indicating that thus far their treatment had been successful. But I agree with @Marie Bell that the defense will probably try to make as much of the adrenaline dosing as possible.

 

[esther43]

Yes. And thinking back to the testimony, the baby had had "a good gas" right before the final, fatal collapse... indicating that thus far their treatment had been successful. But I agree with @Marie Bell that the defense will probably try to make as much of the adrenaline dosing as possible.

Oh totally. Are there two prosecutors in this case? Johnson and Andrews? I wonder if they've got anything about them and how confident they are on the matter of tacking any medical defence witnesses /experts.
The way the case has been built is a credit to the solicitors, but do the barristers for the prosecution have the drive and passion of Myers? I sure hope they are not going to stand there asking dry questions, expecting a silenced jury to pick up on subtleties.

 

[Sweeper2000]

Yes. And thinking back to the testimony, the baby had had "a good gas" right before the final, fatal collapse... indicating that thus far their treatment had been successful. But I agree with @Marie Bell that the defense will probably try to make as much of the adrenaline dosing as possible.

I suppose it’s a good idea to ask this. In modern times how reliably and quickly can symptoms be recognised on a NNU? Say for instance the first signs of infection or other normal problems. we see the word “deterioration“ frequently in this but would a deterioration be expected after identifying symptoms or can it be a quick escalation ?

 

[esther43]

I suppose it’s a good idea to ask this. In modern times how reliably and quickly can symptoms be recognised on a NNU? Say for instance the first signs of infection or other normal problems. we see the word “deterioration“ frequently in this but would a deterioration be expected after identifying symptoms or can it be a quick escalation ?

So when my daughter was born at 25+1. Due to her gestation she was cared for in a level 3 along with other babies of a similar size. In the first 8 weeks she was very unstable.Desats and Apnoea are common and apnoea is often not related to ill health but due to the part of the brain that matures breathing regulation. Sometimes these little babies will need a bit of stimulation to get them breathing again, or they will need extra breaths which will give them a little boost. So it's a 'deterioration' but it is an expected part of maturing the baby in an incubator.
When they are getting sick, say as a result of pneumonia, sepsis or NEC. Then the pattern on the monitor changes and instead of having the occasional apneoa or desat, they start to come in clusters. So then you see more prolonged periods of instability. You will also see the heart rate dropping, together with the apneoa.
However, this deterioration would usually be expected to last days, not hours and definitely not minutes. There would be opportunities to assess the situation, add in antibiotics, increase respiratory support etc.
Now, that's what would happen with an extremely pre term baby. But once babies get to 28 weeks gestation, they do this a lot less, they are less prone to all problems, including apnoea of prematurity.
Within neonates a number of common problems that can slow down the process of 'maturing the baby' They are genetic problems, PDA (a hole in the heart), chronic lung disease, a brain bleed or NEC or jaundice.
Assessment of these problems occurs on a daily basis, by both the nursing team and doctors. Their approach to treatment is to look out for all these issues and be ready to step in very promptly to prevent and control infection or any other problems relating to prematurity.
Anyhow that's my layman's analysis of neonatal care! Obviously there's a hell of a lot more to it than that, but my best effort in a nutshell.

 

[magikarpmagikarp]

I suppose it’s a good idea to ask this. In modern times how reliably and quickly can symptoms be recognised on a NNU? Say for instance the first signs of infection or other normal problems. we see the word “deterioration“ frequently in this but would a deterioration be expected after identifying symptoms or can it be a quick escalation ?

O and P were 2 and 3 days old, I believe.

Babies admitted to the neonatal unit often have a sepsis evaluation at admission (birth). This is based on risk factors and the delivery room history. After 36 hours or so of antibiotics, and a negative blood culture, they are considered to have "ruled out." If they show signs of infection after this point, they get a full 5 or 7 day course of antibiotics. For some reason I recall reading that the triplets had "ruled out" and were off antibiotics, but I can't find a source. Anyhow, it doesn't matter for the purpose of this comment.

Babies who, based on risk factors, did not require a sepsis evaluation can of course still become ill. Usually the first sign will be some respiratory distress: breathing fast, working hard to breathe, noisy breathing. If it is a bowel infection, there may also be abdominal distension, vomiting, and sometimes bloody stools. Sometimes there will be an event - a blue spell - an apnea/bradycardia/desat. At this point, the baby may be re-evaluated for infection using the appropriate tools and investigations (which was done). It is really quite UNusual (edit - thank you @ColourPurple !) for the first sign of illness to be a full respiratory/cardiac arrest, especially when previous investigations were reassuring. Once again, only my opinion.

 

[marynnu]

So when my daughter was born at 25+1. Due to her gestation she was cared for in a level 3 along with other babies of a similar size. In the first 8 weeks she was very unstable.Desats and Apnoea are common and apnoea is often not related to ill health but due to the part of the brain that matures breathing regulation. Sometimes these little babies will need a bit of stimulation to get them breathing again, or they will need extra breaths which will give them a little boost. So it's a 'deterioration' but it is an expected part of maturing the baby in an incubator.
When they are getting sick, say as a result of pneumonia, sepsis or NEC. Then the pattern on the monitor changes and instead of having the occasional apneoa or desat, they start to come in clusters. So then you see more prolonged periods of instability. You will also see the heart rate dropping, together with the apneoa.
However, this deterioration would usually be expected to last days, not hours and definitely not minutes. There would be opportunities to assess the situation, add in antibiotics, increase respiratory support etc.
Now, that's what would happen with an extremely pre term baby. But once babies get to 28 weeks gestation, they do this a lot less, they are less prone to all problems, including apnoea of prematurity.
Within neonates a number of common problems that can slow down the process of 'maturing the baby' They are genetic problems, PDA (a hole in the heart), chronic lung disease, a brain bleed or NEC or jaundice.
Assessment of these problems occurs on a daily basis, by both the nursing team and doctors. Their approach to treatment is to look out for all these issues and be ready to step in very promptly to prevent and control infection or any other problems relating to prematurity.
Anyhow that's my layman's analysis of neonatal care! Obviously there's a hell of a lot more to it than that, but my best effort in a nutshell.

Brilliantly explained. Most infants are quite predictable, and as you say the signs & symptoms of infection take a similar path. Not only that, babies are screened for infection weekly or more.

 

[esther43]

Brilliantly explained. Most infants are quite predictable, and as you say the signs & symptoms of infection take a similar path. Not only that, babies are screened for infection weekly or more.

Thanks Mary. I will take that as a compliment coming from you

 

[ColourPurple]

DBM

 

[Parker Knoll]

Oh totally. Are there two prosecutors in this case? Johnson and Andrews? I wonder if they've got anything about them and how confident they are on the matter of tacking any medical defence witnesses /experts.
The way the case has been built is a credit to the solicitors, but do the barristers for the prosecution have the drive and passion of Myers? I sure hope they are not going to stand there asking dry questions, expecting a silenced jury to pick up on subtleties.

NJ is very capable but Myers a different league.

 

[esther43]

NJ is very capable but Myers a different league.

I thought most barristers were theatrical in nature but it remains to be seen with Johnson.
Fire rocket anyone?

 

[magikarpmagikarp]

RSBM

Do you mean unusual?

Hah yes!!

 

[katydid23]

This is precisely the point I've made several times regarding the attempted murder charges. When this all started I was fairly stunned at the sheer number of them because attempted murder is a very difficult thing to prove, much more so than murder as an intent to kill is not required; it is necessary that the accused intended that death would occur and that is exceptionally difficult to prove without extremely compelling evidence. That intention is not required for murder.

In this particular case, with this many charges, for this many attempts, I don't think it matters if the intention was absolute murder or 'near death.' . This case is very different because the intention seemed to be to bring babies to the brink of death, and then maybe bring them back, but maybe not. It seems the intention was to bring the chaos and intensity of the crash cart and resuscitation efforts, and see what happens.

The courts and the public are not going to ignore that behaviour just because it may or may not fit perfectly with previous attempted murder cases. This particular defendant does not fit the pattern of the usual allegations. But that does not mean they should not be held responsible, if the allegations are found to be valid. JMO

 

[marynnu]

O and P were 2 and 3 days old, I believe.

Babies admitted to the neonatal unit often have a sepsis evaluation at admission (birth). This is based on risk factors and the delivery room history. After 36 hours or so of antibiotics, and a negative blood culture, they are considered to have "ruled out." If they show signs of infection after this point, they get a full 5 or 7 day course of antibiotics. For some reason I recall reading that the triplets had "ruled out" and were off antibiotics, but I can't find a source. Anyhow, it doesn't matter for the purpose of this comment.

Babies who, based on risk factors, did not require a sepsis evaluation can of course still become ill. Usually the first sign will be some respiratory distress: breathing fast, working hard to breathe, noisy breathing. If it is a bowel infection, there may also be abdominal distension, vomiting, and sometimes bloody stools. Sometimes there will be an event - a blue spell - an apnea/bradycardia/desat. At this point, the baby may be re-evaluated for infection using the appropriate tools and investigations (which was done). It is really quite UNusual (edit - thank you @ColourPurple !) for the first sign of illness to be a full respiratory/cardiac arrest, especially when previous investigations were reassuring. Once again, only my opinion.

Actually, all babies admitted to NNUs have a basic screen for infection in the way of swabs, but not all have blood cultures.

 

[magikarpmagikarp]

Actually, all babies admitted to NNUs have a basic screen for infection in the way of swabs, but not all have blood cultures.

Respiratory swabs? Sounds much nicer than a blood culture.

 

[katydid23]

I'm quite surprised they're attempted murder charges, rather than assault.

I don't know. As a nurse, she'd know that if she, allegedly, tainted the TPN with insulin, or sent air through the line, it could be lethal. I would count that as attempted murder, not just assault.

 

[Parker Knoll]

I just hope and pray the jury can reach verdicts.

 

[Becci]

How would dr bohin know the ventilator was set to high pls? Does that info come from the machine or notes?

 

[esther43]

O and P were 2 and 3 days old, I believe.

Babies admitted to the neonatal unit often have a sepsis evaluation at admission (birth). This is based on risk factors and the delivery room history. After 36 hours or so of antibiotics, and a negative blood culture, they are considered to have "ruled out." If they show signs of infection after this point, they get a full 5 or 7 day course of antibiotics. For some reason I recall reading that the triplets had "ruled out" and were off antibiotics, but I can't find a source. Anyhow, it doesn't matter for the purpose of this comment.

Babies who, based on risk factors, did not require a sepsis evaluation can of course still become ill. Usually the first sign will be some respiratory

I just hope and pray the jury can reach verdicts.

I hope that someone on the jury can develop an effective format for group analysis. My biggest fear is a lack of structure. Control freak that I am

 

[Marie Bell]

I think they were working with the unknown and adrenaline had worked on previous collapses of a similar nature. It's alleged the air bubble blocked the chambers of the heart, so really the amount of adrenaline is not the concern here. It's not as though the adrenalin itself was administered with ill intent.

As I said, I won't be surprised to see the Defence bringing it up though, especially as the prosecution witness introduced the 'competent doctor' factor. I'd definitely be doing the 'even competent doctors evidently make mistakes' thing if I were the defence barrister. After all, it's the jury of lay persons that they're going to be addressing. The prosecution will address it too; pointing out that what mistakes that were made have all been identified and admitted, and didn't cause or contribute to the deaths.

 

[Becci]

As I said, I won't be surprised to see the Defence bringing it up though, especially as the prosecution witness introduced the 'competent doctor' factor. I'd definitely be doing the 'even competent doctors evidently make mistakes' thing if I were the defence barrister. After all, it's the jury of lay persons that they're going to be addressing. The prosecution will address it too; pointing out that what mistakes that were made have all been identified and admitted, and didn't cause or contribute to the deaths.

Who did the adrenaline or was it not said ty